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Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms
OBJECTIVES: Coronary microvascular dysfunction (CMD) is considered to cause angina pectoris in a large proportion of women with no obstructive coronary artery disease (CAD). However, data supporting a relation between angina pectoris and CMD are limited. We compared CMD in women with angina with asy...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816930/ https://www.ncbi.nlm.nih.gov/pubmed/33462108 http://dx.doi.org/10.1136/openhrt-2020-001486 |
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author | Bove, Kira Bang Michelsen, Marie M Schroder, Jakob Suhrs, Hannah Elena Bechsgaard, Daria F Mygind, Naja Dam Aziz, Ahmed Kastrup, Jens Gustafsson, Ida Prescott, Eva |
author_facet | Bove, Kira Bang Michelsen, Marie M Schroder, Jakob Suhrs, Hannah Elena Bechsgaard, Daria F Mygind, Naja Dam Aziz, Ahmed Kastrup, Jens Gustafsson, Ida Prescott, Eva |
author_sort | Bove, Kira Bang |
collection | PubMed |
description | OBJECTIVES: Coronary microvascular dysfunction (CMD) is considered to cause angina pectoris in a large proportion of women with no obstructive coronary artery disease (CAD). However, data supporting a relation between angina pectoris and CMD are limited. We compared CMD in women with angina with asymptomatic women and evaluated the relation between presence of CMD, angina characteristics, cardiovascular risk factors and results of stress testing. METHODS: In a cross-sectional study, we included 1684 women with angina and <50% coronary artery stenosis on invasive angiography. Asymptomatic women from the community-based Copenhagen City Heart Study served as reference group (n=102). Coronary microvascular function was determined by coronary flow velocity reserve (CFVR) assessed by transthoracic Doppler stress echocardiography. CFVR < 2 was defined as CMD. Symptoms were obtained from standardised angina questionnaires and results of stress testing from health records. RESULTS: Median CFVR was 2.33 (IQR 2.00–2.75) in symptomatic women versus 2.60 (2.19–2.95) in asymptomatic (p=0.007). CFVR <2 was found in 25% of symptomatic and in 19% of asymptomatic women. Symptomatic women had a greater risk factor burden. After adjusting for age, hypertension, diabetes, smoking and heart rate the difference in CFVR between groups disappeared (p=0.213). We found no associations between CFVR and angina characteristics, symptom burden or results from stress testing. CONCLUSIONS: Impaired CFVR is more prevalent in symptomatic than in asymptomatic women and related to the cardiovascular risk factors hypertension, diabetes, smoking and increased heart rate. Neither a positive bicycle test, single photon emission CT stress test nor chest pain characteristics identify women with impaired CFVR among women with angina and no obstructive CAD. Results may question the concept of microvascular angina as currently defined. |
format | Online Article Text |
id | pubmed-7816930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-78169302021-01-28 Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms Bove, Kira Bang Michelsen, Marie M Schroder, Jakob Suhrs, Hannah Elena Bechsgaard, Daria F Mygind, Naja Dam Aziz, Ahmed Kastrup, Jens Gustafsson, Ida Prescott, Eva Open Heart Aortic and Vascular Disease OBJECTIVES: Coronary microvascular dysfunction (CMD) is considered to cause angina pectoris in a large proportion of women with no obstructive coronary artery disease (CAD). However, data supporting a relation between angina pectoris and CMD are limited. We compared CMD in women with angina with asymptomatic women and evaluated the relation between presence of CMD, angina characteristics, cardiovascular risk factors and results of stress testing. METHODS: In a cross-sectional study, we included 1684 women with angina and <50% coronary artery stenosis on invasive angiography. Asymptomatic women from the community-based Copenhagen City Heart Study served as reference group (n=102). Coronary microvascular function was determined by coronary flow velocity reserve (CFVR) assessed by transthoracic Doppler stress echocardiography. CFVR < 2 was defined as CMD. Symptoms were obtained from standardised angina questionnaires and results of stress testing from health records. RESULTS: Median CFVR was 2.33 (IQR 2.00–2.75) in symptomatic women versus 2.60 (2.19–2.95) in asymptomatic (p=0.007). CFVR <2 was found in 25% of symptomatic and in 19% of asymptomatic women. Symptomatic women had a greater risk factor burden. After adjusting for age, hypertension, diabetes, smoking and heart rate the difference in CFVR between groups disappeared (p=0.213). We found no associations between CFVR and angina characteristics, symptom burden or results from stress testing. CONCLUSIONS: Impaired CFVR is more prevalent in symptomatic than in asymptomatic women and related to the cardiovascular risk factors hypertension, diabetes, smoking and increased heart rate. Neither a positive bicycle test, single photon emission CT stress test nor chest pain characteristics identify women with impaired CFVR among women with angina and no obstructive CAD. Results may question the concept of microvascular angina as currently defined. BMJ Publishing Group 2021-01-18 /pmc/articles/PMC7816930/ /pubmed/33462108 http://dx.doi.org/10.1136/openhrt-2020-001486 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Aortic and Vascular Disease Bove, Kira Bang Michelsen, Marie M Schroder, Jakob Suhrs, Hannah Elena Bechsgaard, Daria F Mygind, Naja Dam Aziz, Ahmed Kastrup, Jens Gustafsson, Ida Prescott, Eva Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title | Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title_full | Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title_fullStr | Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title_full_unstemmed | Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title_short | Impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
title_sort | impaired coronary flow velocity reserve is associated with cardiovascular risk factors but not with angina symptoms |
topic | Aortic and Vascular Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816930/ https://www.ncbi.nlm.nih.gov/pubmed/33462108 http://dx.doi.org/10.1136/openhrt-2020-001486 |
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